ALEXANDRIA, VA, December 1, 2009—Constraint-induced movement
therapy (CIMT) is a potentially effective form of intervention for
children with hemiplegic cerebral palsy, but more research is needed,
according to a new systematic review published in the November issue of
Physical Therapy (PTJ), the scientific journal of the American
Physical Therapy Association (APTA). The review, which analyzed 21
intervention studies and 2 systematic reviews, concluded that further
research should focus on the frequency, duration, and type of constraint
used to treat the affected limb. Similar gains may be achieved when both
arms are used together during therapy, but there have not as yet been
sufficient studies that compare these two types of physical therapy.
Moreover, the review concluded that there is insufficient research on
the impact of CIMT on a developing child's undamaged brain regions and
that more investigation is needed.
Hemiplegic cerebral palsy affects one arm and leg on the same side of
the body. CIMT forces the use of the affected side, specifically the
upper extremity, by gently restraining the unaffected side in a mitt,
sling, or cast. The patient then practices moving the affected arm for
varying durations of time and intensity. Previous studies showed support
for the use of CIMT to improve the frequency of use of the affected arm
for children with hemiplegia. In most studies, positive effects were
demonstrated 6 to 8 months after intervention.
"Although previous studies reveal a marked increase in function of
the affected limb, there is a strong need for more rigorous studies to
determine what constitutes an adequate dose of CIMT for pediatric
patients with hemiplegia," said physical therapist Linda Fetters, PT,
PhD, FAPTA, the holder of the Sykes Family Chair in Pediatric Physical
Therapy, Health, and Development in the Division of Biokinesiology and
Physical Therapy, and a professor in the Department of Pediatrics at the
Keck School of Medicine at the University of Southern California.
This systematic review specifically focused on research involving
children younger than 18 years of age, as the central nervous system in
these young children is still in the early stages of development. One of
the theories behind the success of CIMT in children is that the
developing brain has the capacity to reorganize learning.
"What we don't yet know is the impact of prolonged restraint on a
child's developing nervous system," said first author Hsiang-han Huang,
MS, OT, a ScD student in the Department of Physical Therapy and Athletic
Training at Boston University. "Depending on the stage of development
during which CIMT is applied, its potential impact may differ."
Physical therapists are highly-educated, licensed health
care professionals who can help patients reduce pain and improve or
restore mobility — in many cases without expensive surgery or the
side effects of prescription medications. APTA represents approximately
76,000 physical therapists, physical therapist assistants, and students
of physical therapy nationwide. Its purpose is to improve the health and
quality of life of individuals through the advancement of physical
therapist practice, education, and research.In most states, patients can
make an appointment directly with a physical therapist, without a
physician referral. Learn more about conditions physical therapists can
treat and find a physical therapist in your area at www.moveforwardpt.com.